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DSCC Heart Failure
Heart Failure
| Question | Answer |
|---|---|
| Causes of Left-sided HF | HTN, CAD, valvular dz (mitral/aortic) |
| Causes of Right-sided HF | Left ventricular failure, right-sided MI, pulmonary HTN |
| What does the sympathetic nervous system do to compensate for HF? | Increases catecholamines (->hypoxia), beta adrenergic (increases HR), and alpha adrenergic (increases BP) |
| What is activated by decreased blood flow to the kidneys d/t HF? | RAS - Renin-Angiotensin System |
| What is released by the RAS do in response to HF? | Angiotensin II (causing vasoconstriction) and aldosteron (causing Na and H2O retention) |
| What are the bodies chemical responses to HF? | MI:immune response releases tumor necrosis factor (TNF) and interleukins (IL-1 & IL-6); CHF: natriuretic peptides (B-type [BNP]) is released with fluid overload |
| Why does the heart enlarge (myocardial hypertrophy) in response to HF? | To provide more muscle mass for more forceful contractions |
| S/S of left-sided HF: | -Early manifestations: fatigue, activity intolerance -Dizziness, syncope -Dyspnea, SOB, DOE, cough, orthopnea, cyanosis -Oliguria (day), nocturia -Inspiratory crackles & wheezes -Pulmonary congestion & decreased cardiac OP -S3/S4 gallop |
| S/S of right-sided HF: | -Weight gain, swollen hands/fingers -Increased BP -Lower extremity edema -Liver engorgement, RUQ pain -JVD -Impairment of right ventricle |
| S/S of pulmonary edema: | -Disorientation/acute confusion -Anxiety/restlessness -Dyspnea at rest -Hyper- or hypo- tension -Tachycardia -Crackles -Dysrhythmias: PVCs (premature ventricular contraction) -COUGH WITH PINK, FROTHY SPUTUM |
| How to position pt with pulmonary edema: | -Hi-Fowler's c legs down if not hypotensive |
| Nursing care for pulmonary edema: | -Hi-flow O2 @ 5-6L/min by face mask or @ 10-15L/min by non-rebreather -Pulse ox & cardiac monitoring -May need CPAP or mechanical ventilation -NTG, SL q5 min x 3 doses if SBP > 100 -Obtain IV access -VS q30 min-1 hr |
| Meds given in case of pulmonary edema: | -Lasix or Bumex -Morphine (decreased venous return, anxiety and workload of breathing |
| What is the best tool for dx HF? | Echocardiogram |
| What monitors heart pressures? | Pulmonary artery catheter |
| Nursing interventions for Ace inhibitors: | Monitor BP, K levels (increased), and WBC (neutropenia) |
| Ace inhibitors end in: | aPRIL |
| Which type of med for HF is given to decrease after-load, improve cardiac OP & renal blood flow? | Ace inhibitors |
| Which type of med for HF is given to decrease pulmonary congestion & peripheral edema? | Ace inhibitors |
| ARBS = | Angiotensin II Receptor Blockers |
| Nursing interventions for ARBS: | Monitor BP & K levels |
| The generic names of these meds end in -artan: | ARBS |
| How do ARBS meds work? | -Block the action of angiotensin II @ receptor -->decreased arterial resistance & arterial dilation -Block aldosterone -->preventing Na & H2O retention |
| Diuretics given c HF: | Lasix, Aldactone, HCTZ |
| This drug improves contractility in HF: | Digoxin (Lanoxin) |
| When would you hold a dose of digoxin? | If apical HR is < 60 |
| With which med would you assess apical HR for 1 full minute prior to admin? | Digoxin |
| S/S of digitalis toxicity: | -Anorexia -Fatigue -Bradycardia -Dysrhythmias -YELLOW HALOS |
| What would you administer if your pt showed s/s of digitalis toxicity? | Digibind |
| These pts should be monitored especially carefully when on digoxin? | Pts c renal failure |
| Dopamine and dobutamine are: | Sympathomimetic agents |
| Why is dobutamine preferred over dopamine? | It doesn't increase HR |
| Nursing interventions when giving sympathomimetics: | Monitor BP |
| These meds are given by IV and can be titrated: | Dopamin & dobutamine |
| These phosphodiesterase inhibitors end in: | -cor |
| Which type of meds increase contractility and cause vasodilation (increasing cardiac OP & decreasing after-load? | Phosphodiesterase inhibitors |
| You would not want to d/c these meds abruptly: | Inocor & Primacor |
| Hepatoxicity & thrombocytopenia are risks for pts taking what med? | Inocor |
| Impaired Gas Exchange r/t Heart Failure nursing interventions: | -Monitor resp. status:rate, rhythm, quality -Auscultate breath sounds -Monitor O2 sats; provide supplemental O2 PRN -TCDB q2 hr & PRN -Maintain Hi-Fowler's positioning |
| Decreased Cardiac OP r/t HF nursing interventions for positioning: | Elevate HOB |
| S/S of decreased cardiac OP and tissue perfusion: | -Changes in LOC -Decreased urine OP -Cool.clammy skin -Diminished pulses -Dysrhythmias |
| Other nursing interventions for decreased cardiac OP r/t HF: | -Monitor VS and O2 sats PRN -Monitor BNP levels; report trends -Auscultate heart & lung sounds -Admin O2 PRN -Admin meds as scheduled -Encourage rest, explain rationale -Avoid valsalva maneuver |
| Activity Intolerance r/t HF nursing interventions: | -Organize nursing care to allow rest periods -Assist c ADLs PRN; encourage independence within prescribed limitations -Use passive & active ROM exercises; consult PT -Provide written & verbal info about activity after discharge |
| No limits: ordinary physical activity does not cause undue tiredness or SOB | Class I |
| Slight or mild limits: comfortable @ rest, but ordinary physical activity results in tiredness or SOB | Class II |
| Marked or noticeable limits: comfortable @ rest, but less than ordinary physical activity causes tiredness & SOB | Class III |
| Severe limits: unable to carry on any physical activity w/o discomfort; symptoms are also present @ rest | Class IV |
| Nursing Dx r/t HF: | -Impaired Gas Exchange -Decreased Cardiac OP -Activity Intolerance -FVE -Ineffective Tissue Perfusion -Anxiety -Ineffective Therapeutic Regimen Management |
| Nutrition management for HF: | -Limit Na intake to 2-3g/day -Limit fluid intake to 2L/day |
| Surgical management for HF: | -Ventricular-assistive devices (VADs) -Heart Transplantation |
| Which med should pts c HF avoid? | NSAIDS |
| Pre-Load (rubber band) | Volume coming into ventricles(end diastolic pressure) |
| When is pre-load increased? | -Hypervolemia -Regurgitation of cardiac values |
| After-Load (balloon) | Resistance that left ventricle must overcome to circulate blood |
| When is after-load increased? | -HTN Vasoconstriction-->increased after-load & increased cardiac workload |
| Actions of ACE inhibitors: | Decrease peripheral vascular resistance w/o increasing cardiac OP, HR or contractility |
| S/E of Ace inhibitors: | -Dizziness -Orthostatic hypotension -GI Distress -HA -COUGH |
| Beta-Blockers end in: | -olol |
| Actions of beta-blockers: | Blocks beta receptors in the heart causing decreased HR, force of contraction & rate of A-V conduction |
| S/E of Beta-blockers: | -Bradycardia -Lethargy -GI Disturbance -CHF -Decreased BP -DEPRESSION |
| Treatment goals for HF: | -Improve cardiac fx -Remove accumulated fluid & Na -Decrease cardiac demands -Improve tissue oxygenation |
Created by:
shall5
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